Diabetes Meds Flashcards
1st line tx for DM II
Metformin
Metformin mechanism
decrease Liver production of glucose (no effect on beta cells)
Added benefits:
- weight loss
- decrease triglycerides
- dec CVD risk
SE of GI complaints, metallic taste, Vit B12 def, Lactic acidosis
Metformin
Sulfa meds
“Gl____”
2nd gen (used more often)
- Glyburide
- Glipizide
- Glimepiride
1st gen
- Tolbutamide
- Chlorpropamide
Mechanism of sulfa
Stimulate beta cell Insulin release
similar glycemic efficacy as Metformin
SE of Sulfa
HYPOGLYCEMIA risk
Weight gain
Chlorpropamide (a 1st gen Sulfa med) has unique SE
Hyponatremia (low sodium)
Disulfuram like rxn (do not drink alcohol)
Meglitinides
“___glinide”
Repaglinide
Nateglinide
Repaglinide
Nateglinide
mechanism
Stimulate beta cell Insulin release
more so post prandial
SE of Metiglinides are same as sulfa
Hypoglycemia
Weight gain
Repaglinide is a good option for
pts with CKD
nice to the Kidneys
TZDs
Pioglitazone
Rosiglitazone
increase Insulin sensitivity at PERIPHERAL sites
SE of TZD
EDEMA
Fluid retention
BAD for CHF
Increased fractures
do NOT use TZD with
Type I DM HF Hx bladder CA High risk fractures Pregnancy
DPP-4 inhib
“gliptins”
Sitagliptin
Linagliptin
Saxagliptin
Sitagliptin
Linagliptin
Saxagliptin
are all
DPP-4
“gliptins”
Mechanism of “gliptins” (DPP-4 inhibitors)
Slow degradation of GLP-1 allowing that enzyme to do its job
leading to: increased Insulin sens, dec Glucagon secretion, decrease gastric emptying
SE of “gliptins” (DPP-4inibitors)
Acute Pancreatitis HA Hepatitis Skin change Joint pain Renal dysfx
Saxagliptin has a bad rep for being linked to
increased risk of HF (heart failure)
GLP-1 RA
Liraglutide
Exanatide
Dulaglutide
Lira
Exana
Dula
GLP-1 RA
Mechanism of GLP-1 RA
Mimics Incretin
- increase Insulin sensitivity
- decrease Glucagon release
- delay gastric emptying
Added benefits
- weight loss
- decrease CVD events
- no risk of Hypoglycemia if used alone
CONTRA to GLP-1RA
Lira
Exana
Dula
Hx of Gastroparesis
Hx of Pancreatitis
Hx of THYROID CA
Hx of MEN syndrome
SGLT-2 Inhibitors
“flozins”
Empagaflozin
Canagliflozin
Dapagiflozin
SGLT-2 Inhibitors
Proximal tubule
Increase glucose excretion
weak when used alone, thus often used in COMBO with: Pioglitazone, Sitagliptin, or Insulin
Benefit of SGLT-2 Inhibitors
Decrease CVD events
Lower BP
Weight loss
CONTRA to using SGLT “flozins”
Type I DM
or Type II DM if GFR <60 (need a good working kidney to use these)
Canagliflozin has a bad rep for being linked to
Amputation risk!!!
Caution in using SGLT2 inh “flozins” with other meds that can cause Dehydration
NSAIDs
ACE-I
ARBs
Diuretics
SE of SGLT 2 Inhib “flozins”
N/v Thirst AKI (acute kidney injury) Bone fracture UTI Yeast infection
Acarbose
Miglitol
Alpha glucosidase inhibitors
delay intestinal glucose absorption
less potent than Metformin and Sulfa
a-glucosidase inhibitors
- Acarbose
- Miglitol
SE
GI, flatulence, diarrhea, Hepatitis
safe in pts with Kidney issues
Two best meds for MACE prevention
Empagaflozin (SGLT)
Liraglutide (GLP)
Lispro
Aspart
Rapid acting insulin
Lispro, AKA
HUmalog
Aspart, AKA
Novolog
NPH
Lente
Intermediate insulin
Detemir
Glargine
Long acting insulin
Decrease Cardiovascular events
Liraglutide
Empagaflozin
Linked to amputation
Canagaflozin
Linked to Heart Failure
Saxagliptin
Nice to kidneys
Acarbose, Miglitol
Repaglinide
Weight loss
GLP-RA “glutides”
Metformin
SLGT “flozins”
Weight loss
Metformin
Empagaflozin, Canagaflozin, Dapagaflozin
Liraglutide, Exanatide, Dulaglutide
“glutides” and “flozins” and Metformin are special why:
Aid in Weight loss
Aspart “Novolog” and Lispro “Humalog”
Fast acting insulin
Detemir and Glargine
Long acting insulin
Glyburide, Glipizide, Glimepiride
Sulfa diabetes drugs
Bactrim
is a SULFA drug
Trimethoprim/Sulfamethoxazole
What do you need to avoid if pt has Sulfa allergy?
Med names that may be sneaky
Bactrim
Glyburide
Glipizide
Glimepiride
Diagnosing Diabetes
all symbols are Greater than or Equal to
Fasting 126
A1C 6.5%
2 hour test 200
Classic sx + Random 200
Diagnose DM with FASTING glucose
126
Diagnose DM with A1C
6.5%
Diagnose DM with Random glucose
200 + need Classic sx of Hyperglycemia
Diagnose DM with 2 hour test
200
If ASCVD risk is >20%
Need High intensity Statin therapy
Why are Diabetes and ASCVD together so important to keep an eye on?
Those with Diabetes are 2x as likely to die of STROKE or HEART ATTACK than those w/o
MACE
Major Adverse Cardiovascular Event
Meds that help prevent MACE
Flozins (SLGT)
Glutides (GLP-RA)
If pt has ASCVD (Atherosclerotic Cardiovascular Dz)
AND
Diabetes, what should the be on other than the Diabetes meds?
ASA (anti-clot)
Statin
Weight loss
Glutides
Flozins
Safe for HF or CKD
Flozins
If pt needs a cheap Med
TZD
Sulfas (Glyburide, Glipizide, Glimebiride)
What to reach for first in DMII meds?
Metformin
Glutides (GLPra)
Flozins (SLGT)
DM II meds that you generally avoid d/t SE unless pt needs cheap med
Sulfa (Glyburide, Glipizide, Glimepiride)
TZD (Pioglitazone, Rosiglitazone)
TZD risky business
Edema, fluid retention
CHF
Inc fractures
Dangerous w Type 1 DM, Bladder CA, High risk fx, Prego
Good choice for Dual therapy in DM mgmt
Metformin +
Glutide (GLPra)
Flozin (SGLT)
Gliptin (DPP)
1st picks after Metformin
Glutides
Flozins
Glutides and Flozins are 1st picks after Metformin, but what do we need to be aware of with Glutides (GLPra)?
Glutides are a/w increased risk of Thyroid C-cell Tumor Risk
Thyroid C cell tumor risk
Glutides
Liraglutide, Exanatide, Dulaglutide
With Flozins, what do you need to keep in mind?
Making the kidney tubules work harder by excreting more and more glucose
MONITOR GFR!!!
Have to stop if GFR drops below 30
Flozins (SGLT) have a FDA warning for
Quiet DKA
Canagaflozin (SGLT) is a/w
INCREASED AMPUTATION RISK
esp if pt has DM and ASCVD
Eventually, someone with Type II DM might have to start using Insulin if other meds aren’t working
if these values are reached or exceeded
A1C 10%
Glucose 300
Insulin Glargine, aka
Lantus
long acting
Insulin Detemir and Degludec are
Long acting
Insulin NPH, aka
Humilin N
Novolin N
Intermediate acting
Long acting insulin timeline
reaches blood several hours later, but works for 24 hours
Intmdt acting insulin
NPH, Humilin, Novilin
Starts working 2-4 hours later, peaks 4-12, then stops working 12-18 hours later
Regular/SHORT acting insulin
Reaches blood in 30 min
Peaks 2-3 hrs later
Works for 3-6 hours
TImeline for Regular/SHORT acting insulin that is used often
Reach 30 min
Peak 2-3 hr
Last 3-6 hrs
Regular/short acting is DIFFERENT from
RAPID acting
Rapid acting insulin, aka
“mealtime”
“Correction”
Rapid acting insulin is used often
“meal tie”
correction”
Lispro (humalog)
Aspart (novolog)
Glulisine (apidra)
Lispro, aka
Humalog
Rapid acting
Aspart, aka
Novolog
Rapid acting
Timeline for Rapid acting Insulin
Lispro “humalog”
Aspart “Novolog”
“mealtime”
“correction”
Starts working 15 min
Peak 1 hr
Continue working for 2-4 hours
Good candidate for Premixed Insulin
If pt is stable on insulin and diet is same everyday
Poor adherence to basal-bolus regimen
What is the risk with Premixed insulin
Hypoglycemia
Calculating Basal dose
TDD= total daily dose
0.5 x 1 unit x Weight (kg)
Insulin amount should be split between
Basal and Bolus
